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picture1_Tx Antiviral Agents For Hepatitis C Virus Pa Form


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 103x       Filetype PDF       File size 0.22 MB       Source: www.uhcprovider.com


File: Tx Antiviral Agents For Hepatitis C Virus Pa Form
July 2021-E Antiviral Agents for Hepatitis C Virus Authorization Request Part I. Prior Authorization Criteria and Policy I. Eligibility 1. Patient is enrolled in Texas Medicaid. 2. The prescribed treatment ...

icon picture PDF Filetype PDF | Posted on 08 Jan 2023 | 2 years ago

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...July e antiviral agents for hepatitis c virus authorization request part i prior criteria and policy eligibility patient is enrolled in texas medicaid the prescribed treatment agent appropriate age of has a diagnosis chronic hcv confirmed genotype b or if not pan genotypic test results must be obtained within previous years from date required laboratory values section through d form days to female patients pregnancy status determined by conduct as close start possible but no later than negative all ribavirin containing regimens those over documented able become pregnant assessed co infection documentation any additional supporting labs provided requested s health care plan ii approval prescriptions may dispensed maximum day supply products other preferred product will require justification including rationale why indicated does guarantee epclusa sofosbuvir velpatasvir mavyret glecaprevir pibrentasvir vosevi voxilaprevir see package insert fda indications regimen based on applicable dis...
								

							

						
	
												
				
					
					
					
			
					
				
				
		
	

	
		





	

	
				

						

						
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										Category:  Uncategorized / Uncategorized 
										
Posted on: 08 Jan 2023 | 2 years ago
										
										
Tag:
																																		download pdf,
																								antiviral,
																								agents,
																								hepatitis,
																								virus,
																								form,
											                                        
																				
Filetype: PDF
										
File size: 0.22 MB
										
Views: 103x
										
Link recommended: filekonstruksi.com
										
										
										
										

										
Uploaded by:
										Wan learn
											

												Wan learn